by the author of "The Paramedic Heretic" & "America's Dumbest Doctors"

Monthly Archives: March 2013

In the Twilight Zone of medicine, miscreants can look shockingly normal

An east-coast physician who provided in-home services for the elderly pleaded guilty to Health Care Fraud yesterday in U.S. District Court in Trenton, New Jersey.

Doctor Lori Reaves, age 52, who lives in the city of Waterford Works, reversed her original ‘not guilty’ plea, and entered a plea of ‘guilty’ of Insurance Fraud before U.S. District Judge Freda Wolfson in federal court.

Reaves admitted that – for a four-year period between January ’08 and November, 2011 – she generated thousands of fraudulent Medicare bills. Specifically, she grossly exaggerated the amount of time she was spending with each patient. Her scam netted than $500,000 in criminal profits.

According to investigators, Reaves routinely submitted bills that were coded as though she were spending as long as two hours with home-bound patients. In reality, her typical visit was less than 15 minutes.

Court records revealed that none of the 24,000 other physicians in the state of New Jersey billed anywhere near the same amount.

Reaves could be sentenced to 10 years in prison when she is sentenced in July.

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Observations:

Before her life of crime, Lori Reaves attended Kirksville, Missouri College of Osteopathic Medicine. She is board-certified in geriatric and family medicine. She is credited with founding the Visiting Physicians of South Jersey.

According to her website, Lori Reaves was named Doctor of the Year by the American Academy of Home Care Physicians, in 2005.

Three years later she embarked on a scheme to steal hundreds of thousands of dollars from the U.S. taxpayers.

MedicalMiscreants thanks the FBI agents in Newark, under the direction of David Velazquez; Agents of the Department of Health and Human Services;Office of Inspector General’s Agent Tom F. O’Donnell of New York.

This case was prosecuted by Assistant U.S. Attorneys Deborah Gannett and R. David Walk, of the Health Care and Government Fraud Unit in Newark.

On Long Island, New York a physician waging war in the midst of a three-year divorce announced to the media that he was demanding his estranged wife return the kidney he’d been good enough to donate to her years before.

Doctor Richard Batista, a surgeon at Nassau University Medical Center, told reporters that he decided to go public with his demand for “kidney compensation” because he had grown frustrated with the negotiations with his estranged wife.

According to Batista, he was the kidney donor for Dawnell Batista, now age 44, in the summer of 2001. The doctor believes his wife started a long-term affair about two years after her kidney transplant. She subsequently filed for divorce in July 2005.

How’s that for appreciation?

Batista, age 49, who specializes in vascular procedures, stated he had no regrets about donating the kidney to his wife, only that his marriage fell apart. The couple had been married for 11 years and lived in a Massapequa estate. They met while he was working at a hospital and she was training to be a nurse.

The case was apparently the first of its kind in New York state. Julia Rivera of the New York Organ Donor Network said she never heard of anything similar.

“This is extraordinary,” the spokeswoman said.

As of this writing, Dawnell still has her husband’s kidney.

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Our Observations:

Ms. Rivera thinks this case was ‘extraordinary?’

We suspect she doesn’t know enough physicians. We sent her a copy of our book, “America’s Dumbest Doctors,” because, well, we’re here to help.

Research shows a whole ton of new doctors can’t even distinguish abnormal heart sounds. Really.

Duh . . . what’s this thingy for?

I don’t know. But mine’s blue. Is that significant?

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So we now learn it is probable that thousands of modern-day doctors likely do not have the skills to discern heart problems by using their stethoscopes. This revelation comes from The Journal of the American Medical Association – JAMA –a theme issue on medical education.

Can’t hear a thing with it. But Damn! I look good

It seems that two researchers at Allegaheny University of Health Sciences in Philadelphia – Doctors Salvatore Mangione and Linda Nieman – performed stethoscope ability evaluations on more than 450 medical students in their critical, skill-building years. The goal was to determine if these men and women – currently in the advanced training stages – could differentiate 12 different cardiac problems by using their stethoscopes, as they would certainly be called upon to do, following graduation.

They were given a full 90 seconds to listen and were even allowed to listen yet again if needed.

Nobody involved with the test was very happy with the findings.

Because what this simple study revealed is that on average, advanced medical students in the specialty areas of internal medicine and family practice, were not able to recognize 80% of the most common heart problems, that ought to be easily diagnosed through the stethoscope.

Just as ugly, the research showed med students were not improving significantly from their first year in training, even through residency.

Doctors Mangione and Nieman called the number of residents that were competent, “disturbingly low.”

Doctor Howard Weitz, a cardiologist who is indeed stethoscope competent, blames modern, high-tech tests. “Veteran physicians themselves are not becoming proficient at this skill. Then, they pass on to new generations of student-doctors the notion that listening to the heart through the stethoscope is not a skill worth honing.”

He goes on to say this: “For many, the device slung around your neck has become totally useless.”

Not all doctors are qualified to treat patients. Thousands of medical professionals know this. They witness outrageous behavior and remain silent at an appalling cost. I know. I used to be one of them.

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After your lab coat & stethoscope, med school assigns you a mouth zipper

Few of us in emergency medicine make it very far at all in our careers before we find ourselves in the middle of a rescue gone wrong. And I am no exception.

I was a young Paramedic in my third year. My team had responded to a 29-year old San Diego firefighter who, on his day off while riding his bicycle at night, had collided at high speed with a parked truck in his neighborhood. Our patient suffered severe head injuries, two broken arms and lay unconscious in the street when we arrived.

Our team of six went to work in nearly total silence; a synchronized effort to save the life of a colleague who – in his evening routine to stay fit for his own work in rescue – had made a terrible error in judgment.

So in a flurry of activity we cut off his clothes; started IVs; applied oxygen; splinted his body from head to ankles. We assessed his rapid heart rate via our portable EKG machine called the LifePak 5. And when we realized his blood pressure was dropping, we wrapped him in our vinyl, pressurized body suit called the Military Anti Shock Trousers – a MAST suit. By pumping air into the suit, it compresses blood flow in the lower legs, forcing blood up to the heart, lungs & brain, where it’s needed. As we watched his blood pressure rise to a level that would keep him alive, we carefully placed him in the ambulance and rushed off to our trauma center.

At the ER a somber trauma team greeted us at the door. The leader of the team was a physician we all knew, a fellow with little patience, an expensive education and an ego the size of Rhode Island. Unknown to us, that ego was about to kill our unconscious firefighter who lay on his back on our rolling gurney.

As often happens, Paramedics use equipment in the outdoors that is not used in hospitals. In this case, that equipment was our MAST suit. This particular doctor – and just for fun let’s call him Mark the Shark – had no idea what a MAST suit was, and worse, no clue what happens when you pull one off suddenly. So right in the middle of the group effort to safe a life, with 10 of us busy around him, Mark the Shark ignored our orders to leave the suit pressurized until more IV fluid went into him. He ignored the bright yellow label on the front of the MAST suit that reads, “Remove Very Slowly, One Chamber at a Time.” He jerked the abdomenal portion of the suit open in a truly ugly screech of Velco, to the horror of everybody in the room.

The EKG went flatline, and our San Diego firefighter died immediately.

As days and then weeks went by, I expected to be contacted by hospital authorities; county health investigators, maybe even the district attorney’s office, for my version of events that night. I was certain I’d be grilled by my EMS superiors at UCSD school of medicine, on the details. Surely everybody in the room – from trauma nurses to x-ray tech – would be pressed to explain how this avoidable mistake could possibly happen.

Instead, there was nothing but complete silence. And it was a silence that rivaled even the heartbreaking quiet of the 400 of us who attended the firefighter’s funeral.

Within a week everybody in San Diego EMS community knew what had gone wrong and who was responsible, and Mark the Shark was added to our unwritten list of “Doctors Death” – those ER physicians notorious for killing people. Paramedics could come up with very creative ways to avoid certain ERs at certain times. And now we had yet another to sidestep.

But we were all too willing to let the firefighter’s death pass without speaking up for him.

Mark the Shark’s procedural error was the first of two deadly screwups made in this case. His colleagues committed the second error: we chose to overlook a pattern of madness in medicine.

It is not known exactly how many Mark the Sharks are out there killing patients. But according to a Journal of the American Medical Association study, their numbers are likely frightening. A Massachusetts General Hospital survey of thousands of doctors across multiple specialties revealed that nearly one in five reported they had personal knowledge of “impaired and or incompetent” physicians within their own workplace.

One in Five.

So knowing this, wouldn’t a logical position be for healthcare to fast-track a multi-tiered effort to weed out the killers in their mist?

One would certainly think so.

Is it happening?

Not even close.

End result? Well, here we are, 30 years after I personally witnessed an egomaniacal MD kill a patient, yet never even considered telling the widow.

Lefkovitch, who lived in Westlake Village, was first arrested in December, 2010 on assault charges of a 29-year old woman, who tesitifed that the doctor performed a vaginal exam without gloves.

The victim then cooperated with detectives and made phone calls to Lefkovitch, which police monitored without the doctor’s knowledge.

The recorded conversations were played back to the jury. During the calls, Lefkovitch told the victim he found her attractive and apologized for his behavior. He did not deny touching her without gloves.

Another victim came forward a week later. The woman worked as a nurse at Arroyo Oaks and was also a patient of Lefkovitch.

Further investigation by Ventura County detectives revealed two additional victims.

Leftkovitch had pleaded not guilty to all charges.

Due to the nature of the crimes by a medical professional, Judge Edward Brodie determined that public safety concerns barred the doctor from treating patients until the conclusion of the criminal case.

Deputy Attorney General Cindy Lopez urged the judge to impose a “complete shutdown” of Leftkovitch’s medical practice. He was a family practice physician employed by Arroyo Oaks Medical Group in Thousand Oaks.

“This doctor routinely engaged in sexual relations with patients and a staff member, for years,” Lopez told the court. “In the opinion of our expert, this man is a sexual predator.”

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Case Update:

The Thousand Oaks doctor convicted of sexually assaulting female patients was sentenced to 8 years in prison.

Doctor Barry Lefkovitch, now age 58, sat quietly as Ventura County Superior Court Judge Ryan Wright admonished him for mistreating his patients, abusing his authority over subordinates and showing no remorse for his actions.

Wright denied defense attorney Steven Powell’s request for probation and said jury members who convicted Lefkovitch “got it right.”

“The defendant’s lack of remorse in this case is stunning, to say the very least,” Wright said. “He has blamed everyone else but himself. He blamed the victims, police officers, his attorneys and the court. The one person he has not blamed is himself.”

In Savannah Federal Court a psychiatrist has changed his ‘not guilty’ plea of multiple felonies, to ‘guilty.’ His crimes include prescribing drugs for no medical purpose.

Doctor William Ellien, age 57, changed his plea before Judge William Moore.

A spokesman for the U.S. Attorney’s office reported their investigation revealed Ellien would regularly exchange narcotics prescriptions for sex acts, with numerous women, over a four-year period beginning in 2009. Ellien remains in federal custody and is facing a 20-year prison sentence.

According to U.S. Attorney Edward Tarver, “This doctor violated his oath, preyed upon patients, and turned into a common criminal, all for his own personal gratification. Whether street pushers or physicians, all drug dealers can expect that justice will be swift and the punishment will be severe.”

In 2011, the Georgia Medical Society named Ellien a “health care hero” for conducting and sponsoring activities that improved the community’s quality of life.

In a related case, Memorial Health now faces a lawsuit for failing to report Ellien. Five women claim that Ellien used his position at Memorial Health to prey on them, and take advantage of their need for painkillers.

We took a peak at Memorial Health’s interactive website, listed below. We notice that the conviction of a hospital department head on a ‘sex-for-drugs’ scheme isn’t important enough to make their News scroll.

We find this omission curious, because their news motto, right at the top of the page, states this: